gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Transcranial and transorbital ultrasound guiding ICP-management

Transkranieller und transorbitaler Ultraschall als Kontrolle der Hirndrucktherapie

Meeting Abstract

  • corresponding author Jan Regelsberger - Neurochirurgische Klinik, Universitäts-Krankenhaus Eppendorf, Hamburg
  • C. Weber - Neurochirurgische Klinik, Universitäts-Krankenhaus Eppendorf, Hamburg
  • K. Helmke - Kinderradiologie, Universitäts-Krankenhaus Eppendorf, Hamburg
  • M. Westphal - Neurochirurgische Klinik, Universitäts-Krankenhaus Eppendorf, Hamburg

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocP 10.107

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Veröffentlicht: 23. April 2004

© 2004 Regelsberger et al.
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Initial CT-imaging of the brain-injured patient is almost indispensible for further treatment decisions. But whereas neurotraumatic injuries are frequently associated with severe pulmonary disorders, transportation for CT-imaging may be life-threatening for the patient. Especially in the postoperative period, it may not even be feasible. In this context we present our experience with transcranial and transorbital ultrasound.


While CT-imaging was routinely performed, supplemental transcranial PW-doppler, transcranial and transorbital B-scan ultrasound were carried out in the postoperative course of 26 brain-injured patients. Sonographic results were correlated to ICP data.


Intracerebral hemorrhages, midline shifts and enlargement of the ventricles were easily and reliably detected by transcranial B-scan. Further analyses were limited by the temporal bone window. Transorbital measurements of the prominence of the papilla (1mm as an equivalent of 1 diopter), the diameter of the optic nerve (normal range 2.7-5mm) and the width of the third ventricle (2.9-7.5mm) are reliable parameters to verify a raised ICP or local changes of cerebral disorders. These results correlated significantly with the well-known PW-doppler findings where a lowering of the systolic amplitude and a diminution of the diastolic pulse curve sensitively verifies a raised ICP.


We conclude that transcranial and transorbital ultrasound imaging is of great significance in the postoperative period extending the possibilities of neurointensive monitoring. As intracerebral hemorrhages and other mass effects can be reliably excluded by transcranial ultrasound, CT-imaging of the narcotized brain injured patient may be postponed and life-threatening transportation avoided. Transorbital ultrasound has been underestimated so far, however, its potential role is impressively documented by ICP measurements which correspond well with the TCD and the intraparenchymatous ICP data.